STD rapid assessment in Rwandan refugee camps in Tanzania

Reproductive health for refugees by refugees in Guinea II: sexually transmitted infections

Background

Providing reproductive and sexual health services is an important and challenging aspect of caring for displaced populations, and preventive and curative sexual health services may play a role in reducing HIV transmission in complex emergencies. From 1995, the non-governmental "Reproductive Health Group" (RHG) worked amongst refugees displaced by conflicts in Sierra Leone and Liberia (1989–2004). RHG recruited refugee nurses and midwives to provide reproductive and sexual health services for refugees in the Forest Region of Guinea, and trained refugee women as lay health workers. A cross-sectional survey was conducted in 1999 to assess sexual health needs, knowledge and practices among refugees, and the potential impact of RHG's work.

Methods

Trained interviewers administered a questionnaire on self-reported STI symptoms, and sexual health knowledge, attitudes and practices to 445 men and 444 women selected through multistage stratified cluster sampling. Chi-squared tests were used where appropriate. Multivariable logistic regression with robust standard errors (to adjust for the cluster sampling design) was used to assess if factors such as source of information about sexually transmitted infections (STIs) was associated with better knowledge.

Results

30% of women and 24% of men reported at least one episode of genital discharge and/or genital ulceration within the past 12 months. Only 25% correctly named all key symptoms of STIs in both sexes. Inappropriate beliefs (e.g. that swallowing tablets before sex, avoiding public toilets, and/or washing their genitals after sex protected against STIs) were prevalent. Respondents citing RHG facilitators as their information source were more likely to respond correctly about STIs; RHG facilitators were more frequently cited than non-healthcare information sources in men who correctly named the key STI symptoms (odds ratio (OR) = 5.2, 95% confidence interval (CI) 1.9–13.9), and in men and women who correctly identified effective STI protection methods (OR = 2.9, 95% CI 1.5–5.8 and OR = 4.6, 95% CI 1.6–13.2 respectively).

Conclusion

Our study revealed a high prevalence of STI symptoms, and gaps in sexual health knowledge in this displaced population. Learning about STIs from RHG health facilitators was associated with better knowledge. RHG's model could be considered in other complex emergency settings.

Health of Chinese illegal immigrants who arrived by boat on the West Coast of Canada in 1999

This was a retrospective review and descriptive analysis of the findings from the medical screening examinations conducted on the illegal migrants from Fujian Province of China (n = 589) who arrived on four boats on the West Coast of Canada between June 14 and September 9, 1999. The Canadian Navy conducted a screening medical exam of the illegal migrants, with Health Canada and Citizenship and Immigration Canada providing suggestions on the format of the exam. The illegal Chinese migrants were predominantly young, male adults. The most prevalent medical conditions detected were dermatological (55.2%), dental problems (25%), trauma (9.2%), urogenital (7.6%), and head/neck (6.6%). Recently induced trauma was more prevalent among females (20.5%) than males (6.5%). One case of community-acquired pneumonia was identified and later diagnosed as active pulmonary tuberculosis. Physicians dealing with illegal migrants should look for unusual physical findings and have a higher clinical suspicion regarding infectious diseases (tuberculosis, scabies) and abuse. Future encounters with illegal migrants should include standardized immigration screening exams, with adequate history taking and follow-up.

Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program

OBJECTIVES

This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya.

METHODS

Health clinic data, quality control data, and costs were analyzed.

RESULTS

The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112.

CONCLUSIONS

The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.